Healthcare Provider Details

I. General information

NPI: 1740681246
Provider Name (Legal Business Name): DENISE SILT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1148 GRAND AVENUE
ST. PAUL MN
55105
US

IV. Provider business mailing address

1148 GRAND AVENUE
ST. PAUL MN
55105
US

V. Phone/Fax

Practice location:
  • Phone: 651-690-5352
  • Fax: 651-209-8065
Mailing address:
  • Phone: 651-690-5352
  • Fax: 651-209-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number145625-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: